Correlation between cerebral blood volume values and outcomes in endovascular therapy for acute ischemic stroke

Maxim Mokin; Simon Morr; Andrew A Fanous; Hussain Shallwani; Sabareesh K Natarajan; Elad I Levy; Kenneth V Snyder; Adnan H Siddiqui

doi:10.1136/neurintsurg-2014-011279

Correlation between cerebral blood volume values and outcomes in endovascular therapy for acute ischemic stroke

J Neurointerv Surg. 2015 Oct;7(10):705-8. doi: 10.1136/neurintsurg-2014-011279. Epub 2014 Aug 21.

Authors

Maxim Mokin¹, Simon Morr¹, Andrew A Fanous¹, Hussain Shallwani¹, Sabareesh K Natarajan¹, Elad I Levy², Kenneth V Snyder³, Adnan H Siddiqui⁴

Affiliations

¹ Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA.
² Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA.
³ Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA.
⁴ Department of Neurosurgery, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Department of Neurosurgery, Gates Vascular Institute, Kaleida Health, Buffalo, New York, USA Department of Radiology, School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York, USA Toshiba Stroke Research Center, University at Buffalo, State University of New York, Buffalo, New York, USA Jacobs Institute, Buffalo, New York, USA.

PMID: 25147229
DOI: 10.1136/neurintsurg-2014-011279

Abstract

Background: Neurointerventionalists do not agree about the optimal imaging protocol when evaluating patients with acute stroke for potential endovascular revascularization. Preintervention cerebrovascular blood volume (CBV) has been shown to predict outcomes in patients undergoing intra-arterial stroke therapies.

Objective: To determine whether CBV can predict hemorrhagic transformation and clinical outcomes in patients selected for endovascular therapy for acute ischemic middle cerebral artery (MCA) stroke using a CT perfusion (CTP)-based imaging protocol.

Methods: We retrospectively reviewed cases of acute ischemic stroke due to MCA M1 segment occlusion and correlated favorable clinical outcomes (modified Rankin scale (mRS) ≤2) and radiographic outcomes with preintervention CBV values. All patients underwent whole-brain (320-detector-row) CTP imaging, and absolute CBV values of the affected and contralateral MCA territories were obtained separately for the cortical and basal ganglia regions.

Results: Relative CBV (rCBV) of the MCA cortical regions was significantly lower in patients with poor clinical outcomes than in those with favorable clinical outcomes (0.87±0.21 vs 1.02±0.09, p=0.0003), and a negative correlation was found between rCBV values and mRS score severity. rCBV of the basal ganglia region was significantly lower in patients with hemorrhagic infarction (p=0.004) and parenchymal hematoma (p=0.04) than in those without hemorrhagic transformation.

Conclusions: We found that cortical CBV loss is predictive of poor clinical outcomes, whereas basal ganglia CBV loss is predictive of hemorrhagic transformation but without translation into poor clinical outcomes. Our study findings support published results of baseline preintervention CBV as a predictor of outcomes in patients undergoing intra-arterial stroke therapies.

Keywords: CT perfusion; Stroke; Technique; Technology.

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MeSH terms

Aged
Aged, 80 and over
Basal Ganglia / blood supply*
Blood Volume / drug effects
Blood Volume / physiology*
Brain Ischemia / diagnostic imaging*
Brain Ischemia / drug therapy
Cerebral Cortex / blood supply*
Cerebrovascular Circulation / drug effects
Cerebrovascular Circulation / physiology*
Female
Humans
Infarction, Middle Cerebral Artery / diagnostic imaging
Infarction, Middle Cerebral Artery / drug therapy
Infusions, Intra-Arterial
Male
Middle Aged
Outcome Assessment, Health Care*
Prognosis
Radiography
Retrospective Studies
Stroke / diagnostic imaging*
Stroke / drug therapy
Thrombolytic Therapy / methods*